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Key Features

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Essentials of Diagnosis
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  • Symptoms appear on the same side as an injury to the neck and shoulder.

  • Burning pain or numbness in the shoulder and arm.

  • Weakness may be present.

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General Considerations
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  • Burners or stingers are common injuries in contact sports, especially football

  • The two terms are used interchangeably to describe transient unilateral pain and paresthesias in the upper extremity

  • These cervical radiculopathies or brachial plexopathies typically occur when the head is laterally bent and the shoulder depressed, causing

    • Exacerbation of a degenerative cervical disk or stenosis

    • A compressive injury to a cervical nerve root on the symptomatic upper extremity

    • Traction injury to the brachial plexus of the ipsilateral shoulder

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Clinical Findings

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  • Immediate burning pain and paresthesias down one arm generally lasting only minutes

  • Unilateral weakness in the muscles of the upper trunk

    • Tends to resolve quickly

    • Can persist for weeks

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Diagnosis

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  • The most important part of the workup is a thorough neurologic assessment to differentiate this injury from a more serious brain or cervical spine injury. The key distinguishing feature of the stinger is its unilateral nature.

  • If symptoms persist or include bilateral complaints, headache, change in mental status, or severe neck pain, a diagnostic evaluation should include

    • A careful neurological examination

    • Possibly cervical spine radiographs, including flexion/extension views, magnetic resonance imaging scans, and electromyography

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Treatment

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  • Consists of removal from play and observation

  • The athlete can return to play once symptoms have resolved, neck and shoulder range of motion is pain-free, reflexes and strength are normal, and the Spurling test is negative

  • The Spurling test is performed by having the neck extended, rotated, and flexed to the ipsilateral shoulder while applying an axial load

  • Restriction of same day return to play should be considered in athletes with a history of multiple stingers, particularly if sustained in the same season

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Outcome

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Prevention
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  • Wearing well-fitting protective gear

  • Proper blocking and tackling techniques

  • Maintaining neck and shoulder strength

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Complications
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  • Long-term complications are possible, including permanent neurologic injury or repeated occurrence of stingers, which would necessitate further workup and possible lifetime exclusion from contact or collision sports

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References

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Cantu  RC, Li  YM, Abdulhamid  M, Chin  LS: Return to play after cervical spine injury in sports. Curr Sports Med Rep 2013;12:14–17
[PubMed: 23314078]
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Standaert  CJ, Herring  SA: Expert opinion and controversies in musculoskeletal and sports medicine: stingers. Arch Phys Med Rehabil 2009;90:402–406
[PubMed: 19254603]

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